Transgender children are being let down by toxic controversy and lack of evidence, a major British report says

LONDON (AP) — Children who question their gender identity are being let down by a lack of evidence and toxic political debate, according to a report released Wednesday from one of England's top doctors.

Dr Hilary Cass said there was “no good evidence on the long-term outcomes of interventions to manage sex-related distress”, and young people were caught up in a “stormy social discourse” around the issue.

“Ideology on all sides has guided care, rather than guiding care through the normal principles of paediatrics and mental health,” said Cass, a retired clinical paediatrician who was appointed to lead a review of gender services for young people by the state-funded NHS. .

On April 1, doctors in Public Health England stopped prescribing puberty-blocking hormones to children and young people with gender dysphoria. The decision followed recommendations in Cass's previous interim report, which said there was insufficient evidence about the potential benefits and harms of blockers, which help prevent people from developing physical features that do not align with their gender identity, such as beards or breasts. .

The decision – which does not represent an outright ban on puberty blockers – has been criticized by some transgender activists and is being closely watched in the United States. Transgender medical care for minors is endorsed by major U.S. medical associations, but several Republican-led states have banned puberty blockers and other treatments for transgender youth — and, in some cases, adults.

The Cass report, which is nearly 400 pages long, said that “for most young people, the medical route” is not the best way to deal with sex-related issues.

Cass said young people who question their gender identity should get a “comprehensive evaluation” including screening for neurodevelopmental conditions such as autism, and a mental health evaluation.

She urged “extreme caution” about giving children or teenagers male or feminizing hormones – testosterone or estrogen – to people under 18.

Prime Minister Rishi Sunak welcomed the review's cautious recommendation.

“We simply do not know the long-term effects of medical treatment or social transformation on them, so we must be very careful,” he said.

Critics accuse Sunak's Conservative government of using the issue of gender identity as a weapon as part of an electoral “culture war” strategy. The government recently issued guidelines for schools stating that teachers should not be required to address children by their preferred pronouns.

Cass said in her report that there was “no clear evidence” that social transition in childhood – such as changing names or pronouns – has any positive or negative consequences for mental health.

The report also concluded that there is no simple explanation for why the number of young people identifying as transgender has risen in recent years in the UK and other countries.

“There is widespread agreement that it is the result of a complex interaction between biological, psychological and social factors,” the report said. “This balance of factors will be different for each individual.”

LGBTQ rights group Stonewall said many of the report's recommendations “can have a positive impact.”

But without due care, training or more capacity in the system, others could create new barriers that prevent children and young people from accessing the care they need and deserve,” said Robbie De Santos, the group's director of campaigns and human rights.